Daugherty Michael, Bratslavsky Gennady
Department of Urology, SUNY Upstate Medical University, Syracuse, NY.
Department of Urology, SUNY Upstate Medical University, Syracuse, NY.
Urol Oncol. 2014 Jul;32(5):549-54. doi: 10.1016/j.urolonc.2013.11.009. Epub 2014 Feb 2.
Compared with radical nephrectomy (RN), partial nephrectomy (PN) decreases the risk of developing chronic kidney disease. Although numerous studies have demonstrated the survival advantage of PN in older patients, they have been criticized by selection bias toward the procedure owing to comorbidities. We hypothesized that long-standing effects of renal preservation would manifest in a survival advantage of a younger patient population, where selection bias owing to comorbidities is minimized.
The Surveillance, Epidemiology, and End Results 18-registries database was queried for patients aged 20 to 44 years surgically treated between 1993 and 2003 for renal cell carcinoma (RCC) ≤ 4 cm with known grade and histology. Patients with prior RCC, multiple tumors, and metastatic or locally advanced disease were excluded. The final cohorts consisted of 222 and 494 subjects treated with PN and RN, respectively. The chi-square and log-rank analyses compared patient and tumor characteristics and patient survival, respectively.
There were no differences between the groups in demographics or tumor characteristics. Additionally, there was no difference in cancer-specific survival at 5 or 10 years (P = 0.34 and P = 0.1, respectively). Although there was no difference in 5-year overall survival (P = 0.07), PN offered an advantage in 10-year overall survival (P = 0.025).
Present Surveillance, Epidemiology, and End Results analyses demonstrate that compared with RN, PN improved overall survival in patients with small, localized RCC. As expected, the survival advantage is observed late and supports the importance of long-term renal functional preservation. Although our study is limited by lack of comorbidities, the results suggest that detrimental effects of RN may have implications on overall survival in younger patients with RCC.
与根治性肾切除术（RN）相比，部分肾切除术（PN）可降低患慢性肾病的风险。尽管大量研究已证实PN在老年患者中的生存优势，但这些研究因合并症导致对该手术存在选择偏倚而受到批评。我们推测，肾脏保留的长期效果将在年轻患者群体的生存优势中体现出来，因为合并症导致的选择偏倚最小。
查询监测、流行病学和最终结果18个登记处数据库，以获取1993年至2003年间接受手术治疗的20至44岁肾细胞癌（RCC）≤4 cm且已知分级和组织学的患者。排除既往有RCC、多发肿瘤以及转移性或局部晚期疾病的患者。最终队列分别由222例接受PN治疗和494例接受RN治疗的受试者组成。卡方检验和对数秩检验分别比较了患者和肿瘤特征以及患者生存率。
两组在人口统计学或肿瘤特征方面无差异。此外，5年或10年的癌症特异性生存率也无差异（分别为P = 0.34和P = 0.1）。虽然5年总生存率无差异（P = 0.07），但PN在10年总生存率方面具有优势（P = 0.025）。
目前的监测、流行病学和最终结果分析表明，与RN相比，PN可提高小的局限性RCC患者的总生存率。正如预期的那样，生存优势在后期才显现，这支持了长期肾功能保留的重要性。尽管我们的研究因缺乏合并症数据而受到限制，但结果表明RN的有害影响可能对年轻RCC患者的总生存有影响。
